NPIMap

Organization Active NPI

Tag Physical Therapy, Inc

  • Physical Therapist
  • El Segundo, CA
National Provider Identifier
1063581965
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT18015 Issued in CA
Legal business name
TAG PHYSICAL THERAPY, INC
Practice address
111 Penn St
El Segundo, CA 90245-3908
Phone
(310) 426-9570
Fax
(310) 426-9572
NPI assigned
Nov 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Melinda Gunter Garvey, PTNPI 1831268739
Title
Owner
Phone
(310) 426-9570

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT18015 CA Primary

Addresses

Primary practice location

111 Penn St
El Segundo, CA 90245-3908

Mailing address

PO Box 1767
El Segundo, CA 90245-6767
Phone (310) 426-9570

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ66790ZOtherCABLUE SHIELD GROUP NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060403000226 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6103834171 Receives reassigned benefits from 17 practitioners
Practice locations: Redondo Beach, CA; Rolling Hills Estates, CA

National Provider Directory

National Provider Directory

Locations

111 Penn St
El Segundo, CA 90245
Phone (310) 426-9570

2015 Manhattan Beach Blvd
Redondo Beach, CA 90278
Phone (310) 426-9570

2015 Manhattan Beach Blvd
Ste 102
Redondo Beach, CA 90278

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063581965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1767",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902456767",
            "telephone_number": "310-426-9570",
            "fax_number": "310-426-9572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 PENN ST",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902453908",
            "telephone_number": "310-426-9570",
            "fax_number": "310-426-9572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAG PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GARVEY",
        "authorized_official_first_name": "MELINDA",
        "authorized_official_middle_name": "GUNTER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-426-9570",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT18015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP NUMBER",
            "identifier": "ZZZ66790Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Segundo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.